One component of the Medicare Access and CHIP Reauthorization Act (MACRA) addresses performance on the use of electronic health records (EHRs), similar to the Meaningful Use program. An organization’s experience with Meaningful Use could be valuable under MACRA, says Julia Adler-Milstein, PhD, assistant professor of health management and policy at the University of Michigan School of Public Health in Ann Arbor.
The performance category addressing EHRs is called Advancing Care Information (ACI). With this measure, physicians can choose to report how they use EHR technology in their daily practice. CMS will look for interoperability, information exchange, and compliance with Office of the National Coordinator for Health IT (ONC) standards. Those standards include allowing patients timely access to EHR information to view, download, and transmit, and the exchange of structured health information with other healthcare providers.
“It’s a lot more information exchange, both with providers and patients,” Adler-Milstein says. “Hospitals are going to be in a world where there is a lot more information going out and coming back in, and I think we’re still learning how to do that well. From an IT perspective, things are going to get more complex as more information is moved around electronically.”
Adler-Milstein notes that the components of MACRA focusing on quality, costs, and EHR utilization are not new, but the rule brings them together and presents the opportunity to make a healthcare organization’s quality improvement efforts more cohesive.
“I don’t think anyone is going to look at any one component and say that’s something they haven’t seen before or haven’t been doing already,” she says. “But MACRA does put them all under one umbrella, and the challenge is going to be putting together a cohesive strategy that makes the most of your resources.”
ACI replaces Meaningful Use for physicians and Medicare, but the old program still applies to hospitals and other eligible professionals. In a CMS blog post announcing the rule, CMS Acting Administrator Andy Slavitt and now-former ONC National Coordinator Karen DeSalvo, MD, said the new ACP approach will be more flexible than Meaningful Use. They also said ACI will reduce the administrative burden and improve patient outcomes in these ways:
- Physicians can select the measures that reflect how technology best suits their day-to-day practice with an EHR.
- ACI provides multiple paths for success.
- The new program aligns with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria.
- APC emphasizes interoperability, information exchange, and security measures, and requires patients to access to their health information through programming interfaces.
- Reporting is simplified. Unlike the Meaningful Use program, ACP does not require an all-or-nothing approach to EHR measurement or quality reporting.
- ACP reduces the number of measures from 18 to 11, and it no longer requires reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures.
- The new program exempts certain physicians from reporting when EHR technology is less applicable to their practice. Some solo physicians also are allowed to report as a group.
Julia Adler-Milstein, PhD, Assistant Professor of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Telephone: (734) 615-7435.